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NPI Code Detail

MEDICARE: MS. BRIANNE L OVERTON FT, LPC, NCC

MEDICARE: MS. BRIANNE L OVERTON FT, LPC, NCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor178.010125IL
2101Y00000XCounselor2017025360MO

General Provider Information

NPI Number : 1578185856
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BRIANNE L OVERTON FT, LPC, NCC
Provider Business Mailing Address
First Line : 616 N 7TH ST APT 810
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63101-1330
Country : US
Telephone Number : 314-221-2964
Fax Number :
Provider Business Practice Location Address
First Line : 3115 S GRAND BLVD STE 400
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63118-1048
Country : US
Telephone Number : 314-221-2964
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2020
Last Update Date : 05/10/2020

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